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Environmental Health Department <br />'r! <br />1. <br />2. <br />Phone: <br />3. <br />4. <br />■5 i(p2. <br />5. <br />6.s <br />9. <br />i <br />meats, tamales, cooked beans, rice, <br />i <br />7, <br />8. <br />SANJOAOUIN <br />■-----COU NTY------ <br />l.' I ?».•( th \ ll> S ib'l I . <br />TEMPORARY FOOD VENDOR’S APPLICATION <br />All food vendors (both for profit and non-profit) are required to return a signed and completed copy of this checklist to <br />the festival coordinator three (3) weeks prior to this event. /p-//Jly ^7 'XO "Z© <br />1. Name of Event: 7—-D a t e ( <br />The following is information about my organization/business: 1 1 <br />Name of organization/business: w Olio Vmlad 01L- <br />Address: PO W > 7 0^ <br />Alternate: ( )T ,----- <br />List food to be sold or given to the public: M <br />I am providing food that is NOT prepared at home: I^Yes U No <br />All food is prepared on-site 05 is from approved commercial facilities: Yes No <br />Name of facility: Phone: ('ZCH] Z-|O_ <br />Address of facility:_ <br />1 am providing a booth with the following: (to protect my unpackaged food and food-preparation areas from flies, <br />dust and the public) <br /> A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br />screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br />asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation’ <br />areas from the public. <br /> Other (specify): ■ ____—■■--------------------------------------- -------------------------- <br />Note: The only operations not required to provide enclosed booths are those which sell beverages from <br />approved dispensers, or prepackaged foods from approved sources. <br />Approved water for drinking, utensil and hand washing will be provided in my booth by the following methods: <br />r I Approved bottled water. <br /> On-site hose bib that is connected to a potable water source. <br />(3 Other (specify): --------------------------------———r----------------------;------------ <br />LamTrovidinTan alluX^ to measure the hot and cold holding of potentially hazardous <br />I Jm°provSing £ol^ holdin9 of al1 Potentially hazardous foods above <br />■ '< -135°F’ <br />fy l camp stove . Slerno & hotel trays <br /> Double steamer' table & lids <br /> Electric stove top Olher (specify) <br />Note: Examples of potentially hazardous food Include; <br />vegetables, potato salad, eggs, and dairy products. <br />' O OS avenue | California 952^11^9 468-3420 J- F 200 464-0138 | W^^ern <br />Bjrj.ifi-fl.z <br />07/3/17 .